BackgroundAntibiotic resistance (ABR) is a serious threat that requires coordinated global intervention to prevent its spread. There is limited data from the English-speaking Caribbean.MethodsAs part of a national programme to address antibiotic resistance in Jamaica, a survey of the knowledge, attitudes and antibiotic prescribing practices of Jamaican physicians was conducted using a 32-item self-administered questionnaire.ResultsOf the eight hundred physicians targeted, 87% responded. The majority thought the problem of resistance very important globally (82%), less nationally (73%) and even less (53%) in personal practices. Hospital physicians were more likely to consider antibiotic resistance important in their practice compared to those in outpatient practice or both (p < 0.001). Composite knowledge scores were generated and considered good if scored > 80%, average if 60–79% and poor if < 60%. Most had good knowledge of factors preventing resistance (83%) and resistance inducing potential of specific antibiotics (59%), but only average knowledge of factors contributing to resistance (57%). Knowledge of preventative factors was highest in females (p = 0.004), those with postgraduate training (p = 0.001) and those > four years post graduation (p = 0.03). Empiric therapy was often directed by international guidelines and cultures were not routinely done. Limited laboratory and human resources were identified as challenges.ConclusionPhysicians in this study were aware of the problem of ABR, but downplayed its significance nationally and personally. These results will guide a national antibiotic stewardship programme.

Introduction: Consistent practice of hand hygiene (HH) has been shown to reduce the incidence and spread of hospital acquired infections. The objectives of this study were to determine the level of compliance and possible factors affecting compliance with HH practices among HCWs at a teaching hospital in Kingston, Jamaica. Methodology: A prospective observational study was undertaken at the University Hospital of the West Indies (UHWI) over a two weeks period. Trained, validated observers identified opportunities for hand hygiene as defined by the WHO "Five Hand Hygiene Moments" and recorded whether appropriate hand hygiene actions were taken or missed. Observations were covert to prevent the observer's presence influencing the behaviour of the healthcare workers (HCWs) and targeted areas included the intensive care units (ICUs), surgical wards and surgical outpatient departments. A ward infrastructure survey was also done. Data were entered and analysed using SPSS version 16 for Windows. Chi-square analysis using Pearson's formula was used to test associations between 'exposure' factors and the outcome 'compliance'. Results: A total of 270 hand hygiene opportunities were observed and the overall compliance rate was 38.9%. No differences were observed between the various types of HCWs or seniority. HCWs were more likely to perform hand hygiene if the indication was 'after' rather than 'before' patient contact (p = 0.001). Conclusion: This study underscores the need for improvement in HH practices among HCWs in a teaching hospital. Health education with particular attention to the need for HH prior to physical contact with patients is indicated.

Introduction: The global dissemination of the New Delhi metallo-beta-lactamase (NDM) gene among certain strains of bacteria has serious implications since the infections caused by such organisms pose a therapeutic challenge. Although the NDM gene has been detected in various parts of the world, this is the first report of its detection in the English-speaking Caribbean. The NDM producing Klebsiella pneumoniae was isolated from an Indian patient who had recently relocated to Jamaica. Methodology: Identification and susceptibility testing of the K. pneumoniae isolate was performed using the Vitek 2 automated system) in keeping with Clinical and Laboratory Standards Institute (CLSI) standards. It was identified as a metallobetalactamase producer using the Rosco KPC+MBL kit. Genotypic screening for common betalactamase (including carbapenemase) genes, was carried out using two multiplex PCRs: one for SHV-, TEM-, CTX-M-, OXA-1-, and CMY-2-types, and one for VIM-, KPC-, IMP-, OXA-48, GES-, and NDM-types. Strain typing was conducted by pulsed-field gel electrophoresis (PFGE) using XbaI and multi-locus sequencing (MLS). Plasmid isolation and analysis was also performed. Results: K. pneumoniae (N11-02395), not previously associated with the dissemination of the NDM in India, Sweden or the UK, was found to harbor the NDM-1 gene on plasmid pNDM112395. Conclusion: The identification of the NDM-1 gene underscores the need for effective surveillance and infection control measures to identify and prevent spread of multidrug resistant Gram negative bacilli. Strict infection control measures implemented for this patient helped to prevent the spread of this organism to other patients.

Objectives To quantitatively determine the antimicrobial susceptibility of clinical Neisseria gonorrhoeae isolates from men with urethral discharge in Jamaica and to describe the syndromic treatment therapies administered. Methods Urethral eSwabs (Copan) were collected from 175 men presenting with urethral discharge to the Comprehensive Health Centre STI Clinic, Kingston, Jamaica. Clinical information was collected and MICs of eight antimicrobials were determined for N. gonorrhoeae isolates (n = 96) using Etest and interpreted using CLSI criteria. Results The median age of the subjects was 28 years (range: 18–73 years) with a median of 2 sexual partners (range: 1–25) per male in the previous 3 months. All examined N. gonorrhoeae isolates were susceptible to ceftriaxone (96/96), azithromycin (91/91), cefixime (91/91) and spectinomycin (91/91). For ciprofloxacin and gentamicin, respectively, 98.9% (91/92) and 91.3% (84/92) of the isolates were susceptible and 1.1% (1/92) and 8.7% (8/92) showed intermediate susceptibility/resistance. For tetracycline and benzylpenicillin, respectively, 38.0% (35/92) and 22.0% (20/91) of the isolates were susceptible, 52.2% (48/92) and 74.7% (68/91) showed intermediate susceptibility/resistance and 9.8% (9/92) and 3.3% (3/91) were resistant. Syndromic treatment was administered as follows: 93.1% received 250 mg of ceftriaxone intramuscularly plus 100 mg of doxycycline orally q12h for 1–2 weeks and 6.9% received 500 mg of ciprofloxacin orally plus 100 mg of doxycycline orally q12h for 1 week. Conclusions Ceftriaxone (250 mg) remains appropriate for gonorrhoea treatment in the examined population of men in Kingston, Jamaica. Surveillance of N. gonorrhoeae AMR should be expanded in Jamaica and other Caribbean countries to guide evidence-based treatment guidelines.

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e43415th ICID Abstracts / International Journal of Infectious Diseases 16S (2012) e317-e473 guideline. The strains were also typed by random amplified polymorphic DNA (RAPD). The lipid A from resistance strains were extracted and subjected to the analysis using MALDI-TOF mass spectrometry.Results: Sensitivity to colistin were determined when the MIC is ≤ 2 g/ml according to CLSI guideline. Of the two hundred strains collected, twenty were found to have MIC ranging from 4 to 128 g/ml. The RAPD grouped the resistance strains into five groups. The MALDI-TOF MS revealed that the basic structure of A. buamannii lipid A is the heptaacylated diphosphoryl lipid A (m/z 1910). The resistance strains exhibited the extra peaks at either m/z 2034, 2071 or 2194, which correspond to the additions of phosphoethanolamine, hexosamine or both to lipid A molecule, respectively. The addition of these residues takes place at the phosphate moieties of lipid A thus potentially cancelling the negative charges and may render A. baumannii the resistance to colistin. Conclusion:The analysis of lipid A from Thai A. baumannii colistin resistance strains demonstrates the modification by which the negative charges were eliminated by the addition of small residues and may subsequently lead to the reduction of colistin target.

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Mullings provides research support to faculty and graduate students. She has a master's degree in Public Health/Health Education and was the first PhD Epidemiology graduate of UWI (2013). She has received academic awards for her work. Her current research interests are mental health, urban health, community health, and related interventions. Her publication record includes one book, two book chapters, 10 journal articles, 27 abstracts, and 12 technical reports. She has held membership in the International Society for Urban Health and International Society for Environmental Epidemiology.Dr. Thoms-Rodriguez has a MD in Microbiology. She lectures at the University of the West Indies, Mona, Jamaica, specializing in Medical Microbiology with special interest in infectious diseases, antibiotic resistance, and control of healthcare-associated infections. She has pursued specialist training in infectious diseases, infection control, and epidemiology surveillance. Dr. Thoms-Rodriguez has published articles in peer-reviewed, refereed journals and has made numerous presentations at international conferences. She recently co-authored a book chapter, "Bacterial Infections in the Oral Cavity: Characterization, Diagnosis, Treatment and Prevention" in Clinical Microbiology for the General Dentist. She holds membership in several learned societies and associations, including the American Society for Microbiology and International Society Infectious Diseases, and is currently President of the Caribbean Association of Clinical Microbiologists.